National Health Insurance Act

The national government may, pursuant to Cabinet Order provisions, provide assistance to each Society in the total sum of the amounts listed in the following items with respect to the cost incurred in providing benefits for medical treatment, etc. and the expenses incurred in paying young-old payments and old-old aid, long-term care payments, contributions for securing medical care in the early phase of an epidemic and children and child-rearing support levies:

the amount obtained by multiplying the total sum of the amounts listed in the following by the ratio specified by Cabinet Order within the range of thirteen hundredths to thirty-two hundredths by taking into consideration the financial capability of the Society:

the amount obtained by deducting, from (1) the total sum of: (i) the amount calculated by deducting, from the expenses incurred in providing benefits for medical treatment, the amount of co-payment relating to such benefits; and (ii) the amount of expenses incurred in paying the expenses for Dietary Treatment for inpatients, Living Support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, transport expenses, high-cost medical expenses and expenses for high-cost medical treatment combined with long-term care, (2) an amount calculated pursuant to Cabinet Order provisions as the amount of such portion of said total sum as relating to the Society's Specified Insured Persons (meaning persons who are insured persons covered by such Society as a result of not being eligible as insured persons under the Health Insurance Act upon the approval under the provisions of item (viii) of paragraph (1) of Article 3 or the proviso of paragraph (2) of the same Article of the same Act as well as insured persons covered by such Society who belong to the above insured persons' respective families; the same shall apply in (b)) (hereinafter referred to as the "Specified Benefit Amount" in this Article);

the amount calculated by deducting, from the amount of expenses incurred in paying young-old payments and old-old aid, long-term care payments, contributions for securing medical care in the early phase of an epidemic and children and child-rearing support levies (or, where any young-old subsidy is payable, the amount calculated by deducting such young-old subsidy from such amount of expenses), the amount calculated pursuant to Cabinet Order provisions as the amount of such portion of said amount of expenses as relating to the Society's Specified Insured Persons (hereinafter referred to as the "Specified Amount of Payment Cost" in this Article);

the total sum of the amount obtained by multiplying the Specified Benefit Amount by a specified ratio and the amount obtained by multiplying the Specified Amount of Payment Cost by a specified ratio.

The specified ratio as referred to in item (ii) of the preceding paragraph shall be a ratio less than thirty-two hundredths, calculated pursuant to Cabinet Order provisions separately for the Specified Benefit Amount and the Specified Amount of Payment Cost by taking into consideration the proportion of assistance provided by the national government with respect to expenses incurred in health insurance services under the Health Insurance Act (including expenses incurred in paying young-old payments and old-old aid, long-term care payments, contributions for securing medical care in the early phase of an epidemic and children and child-rearing support levies) and the financial capability of the Society.

With regard to the application of the provisions of paragraph (1) to a Society which has reduced the ratios for co-payment pursuant to the provisions of Article 43, paragraph (1) or to a Society which has chosen to bear all or part of the amount of the co-payment to be made by all or some of its insured persons, the amount listed in (a) of item (1) of the same paragraph and the Specified Benefit Amount shall be the amount listed in (a) of the same item and the Specified Benefit Amount, respectively, calculated pursuant to Cabinet Order provisions as if the relevant measures to reduce the ratios for co-payment or to bear all or part of the amount of co-payment were not taken.

In cases where providing assistance as set forth in paragraph (1), the national government may, pursuant to Cabinet Order provisions, increase the amount of assistance set forth in the same paragraph by taking into account the financial capability, etc. of the relevant Society.

The total amount by which the amount of assistance may be increased pursuant to the preceding paragraph shall be within the amount equal to 15.4/100 of the total estimated amount of: the amount listed in (a) of item (i) of paragraph (1) and the Specified Benefit Amount (or, where the provisions of paragraph (3) applies to these amounts, the amount calculated by applying the provisions of the same paragraph); and the total sum of the amount listed in (b) of the same item and the Specified Amount of Payment Cost.

Part of the expenses required for the lump-sum allowance for childbirth and childcare (limited to the portion relating to the amount specified by Cabinet Order under Article 101 of the Health Insurance Act (or, where the amount specified by a Prefectural or Municipal Ordinance or constitution based on Article 58, paragraph (1) is less than the amount specified by Cabinet Order under Article 101 of that Act, the amount specified by that Prefectural or Municipal Ordinance or constitution)) is to be covered, pursuant to Cabinet Order provisions, by the childbirth and childcare grants that the organization provides to prefectures or Societies pursuant to the provisions of Article 124-4, paragraph (1) of the Act on Assurance of Medical Care for Elderly People.

The provisions of Articles 152-3 through 152-5 of the Health Insurance Act and Articles 41 and 42 of the Act on Assurance of Medical Care for Elderly People apply mutatis mutandis to childbirth and childcare grants. In this case, any technical replacement of terms necessary for these provisions shall be specified by Cabinet Order.

In addition to what is provided for in Articles 69, 70 and 72, Article 72-3-2, paragraph (2), Article 72-3-3, paragraph (2), Article 72-4, paragraph (2), Article 72-5, paragraph (1) and Article 73, the national government may, within the limits of its budget, assist with one-third of the expenses for public health nurses and with part of the other expenses for national health insurance services.

In addition to what is provided for in Article 72-3, paragraph (2), Article 72-3-2, paragraph (3), Article 72-3-3, paragraph (3) and Article 72-4, paragraph (3), a prefectural or municipal government may provide subsidies or loans with respect to expenses incurred in national health insurance services (including expenses incurred in paying young-old payments, etc. and old-old aid, etc., long-term care payments, contribution for securing medical care in the early phase of an epidemic, etc. under the provisions of the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (hereinafter referred to as "contribution for securing medical care in the early phase of an epidemic, etc.") and children and child-rearing support levies).

In order to ensure the smooth and reliable implementation of national health insurance services, including the provision of insurance benefits, and to adjust finances in accordance with the financial condition and other circumstances of the Municipalities within the prefecture, each prefecture shall, pursuant to Cabinet Order provisions, by Prefectural Ordinance, provide subsidies for national health insurance benefit expenses, etc. to the Municipalities within that prefecture with respect to the cost incurred in providing benefits for medical treatment, etc. and other expenses required for national health insurance services borne in the special account of each such Municipality for national health insurance.

Efforts are to be made to ensure that the provision of subsidies for national health insurance benefit expenses, etc. under the preceding paragraph is carried out consistently with the prefectural national health insurance management policy.

If a prefecture finds that there is a risk that insurance benefits by a Municipality within the prefecture have been provided in violation of the provisions of this Act or other relevant laws and regulations, or improperly, it may, giving reasons, request that Municipality (including, in a case of entrustment of affairs, the Federation of National Health Insurance Associations or the organization that received the entrustment) to re-examine the insurance benefits by that Municipality.

When a Municipality, or a Federation of National Health Insurance Associations or the organization, receives a request for re-examination under the preceding paragraph (hereinafter referred to as a "request for re-examination"), it must re-examine the insurance benefits relating to that request for re-examination and report the results to the prefectural governor.

A prefecture may recommend to the Municipality concerned that it cancel all or part of the insurance benefits, if, despite the prefecture having made a request for re-examination, that Municipality does not cancel all or part of the insurance benefits relating to the request for re-examination, and the prefecture finds that those insurance benefits were provided in violation of the provisions of this Act or other relevant laws and regulations, or improperly (excluding where the examination based on the request for re-examination was conducted by the National Health Insurance Medical Fees Review Committee prescribed in Article 87, paragraph (1) (including, where a Federation of National Health Insurance Associations has, pursuant to the provisions of Article 45, paragraph (6), entrusted affairs concerning the review of medical bills to a corporation designated by the Minister of Health, Labour and Welfare prescribed in that paragraph (hereinafter referred to as a "Designated Association"), the person who conducts the review of those medical bills), or by the Review Committee prescribed in Article 19, paragraph (1) of the Act on the Medical Information Infrastructure and Medical Fee Examination and Payment Organization or the special Review Committee prescribed in Article 24, paragraph (1) of that Act).

In making the recommendation under the provisions of the preceding paragraph, the prefecture must in advance hear the opinion of the Municipality concerned.

When a prefecture has recommended, pursuant to the provisions of paragraph (1) of the preceding Article, that all or part of insurance benefits be canceled, and the Municipality concerned has not complied with the recommendation, the prefecture may, in granting the subsidy for national health insurance benefit expenses, etc., reduce, as provided by Cabinet Order, an amount equivalent to those insurance benefits (limited to the portion pertaining to the recommendation) from the amount of the subsidy for national health insurance benefit expenses, etc.

In order to cover the expenses required for national health insurance services, such as the expenses required for granting subsidies for national health insurance benefit expenses, etc. borne by the special account of the prefecture relating to national health insurance (including the expenses required for paying young-old payments, etc., old-old aid, etc., the long-term care payment, the contribution for securing medical care in the early phase of an epidemic, etc. and the children and child-rearing support levy), a prefecture is to collect payments for national health insurance services expenses from the Municipalities within the prefecture each fiscal year (meaning the period from April 1 each year to March 31 of the following year; the same applies hereinafter), by Prefectural Ordinance, as provided by Cabinet Order.

Municipalities must pay the payments for national health insurance services expenses under the preceding paragraph.

A Municipality must collect insurance premiums from the Householder of the household to which an insured person belongs (limited to a Householder who has a domicile within the area of the Municipality) in order to cover the expenses required for paying payments for national health insurance services expenses borne by the special account of the Municipality relating to national health insurance (including the expenses required for paying young-old payments, etc., old-old aid, etc., the long-term care payment, the contribution for securing medical care in the early phase of an epidemic, etc. and the children and child-rearing support levy borne by the special account relating to national health insurance of the prefecture to which the Municipality belongs; the same applies hereinafter), the expenses required for paying the financial stabilization fund contribution and other expenses required for national health insurance services; provided, however, that this does not apply when national health insurance tax is imposed pursuant to the provisions of the Local Tax Act.

A Society shall collect insurance premiums from Society members to be allocated to the cost incurred in providing benefits for medical treatment, etc. and other expenses for national health insurance services (including expenses incurred in paying young-old payments, etc., old-old aid, etc., the long-term care payment, the contribution for securing medical care in the early phase of an epidemic, etc. and the children and child-rearing support levy and, in the case of a Society set forth in Article 179 of the Health Insurance Act, including expenses incurred in paying day worker contributions under the provisions of the same Act).

Of the insurance premiums under the provisions of the preceding two paragraphs, those to be allocated to expenses incurred in paying the long-term care payment shall be imposed with respect to insured persons who fall under the category of insured person as set forth in Article 9, item (ii) of the Long-Term Care Insurance Act.